The Bright Futures Guidelines, Third Edition Health Promotion Information Sheet TM prevention and health promotion for infants, children, adolescents, and their families TM PROMOTING HEALTHY WEIGHT The Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition features 10 health promotion themes. These state-of-the-art discussions focus on topics of key importance to families and health care professionals in their common mission to promote the health and well-being of children from birth through adolescence. These 10 themes are also woven into the 31 health supervision visits. What you’ll find in the “Promoting Healthy Weight” chapter Overview: Setting the stage Although a child’s weight status is the result of a number of factors working together — including genetics, metabolism, height, behavior, and environment — two of the most important determinants are nutrition and physical activity. A balanced and nutritious diet and regular physical activity are key factors to promoting a healthy weight. This is also true for children and youth with special health care needs who may have additional nutrition and physical activity demands. Because of the important relationship between healthy weight and overall health, and the growing prevalence of overweight and obesity, Bright Futures has identified the promotion of healthy weight as one of two significant challenges to child and adolescent health for this edition of the Guidelines. In-depth: Exploring the topic A number of issues are key to understanding overweight and obesity in children and adolescents: • Defining pediatric overweight and obesity • Prevalence and trends of overweight and obesity in children • Screening for and assessing overweight and obesity • Treating overweight and obesity • Methods of preventing overweight and obesity, such as limiting screen time The chapter also looks at healthy weight issues unique to each developmental stage, along with evidence on the effectiveness of relevant health promotion interventions. Infancy: Birth to 11 Months Exclusive breastfeeding and the avoidance of overfeeding with a bottle are recommended to ensure that growth is adequate and not excessive. The young infant should have multiple opportunities for supervised back and tummy time while awake, and exploration of the environment is encouraged as an age-appropriate physical activity. Early Childhood: 1 to 4 Years Early childhood is the time when a family begins to imprint its habits on a child. This is a period of opportunity when both parents and children can establish healthful eating and activity patterns. The AAP recommends no television viewing for children younger than 2 years, and no more than 1 to 2 hours a day for older children. Middle Childhood: 5 to 10 Years Although parents remain powerful role models when it comes to leading a healthy lifestyle, out-of home influences become more important during this stage, as school routines, the behavior of peers, and community resources may challenge or enrich the child’s eating and activity habits. Adolescence: 11 to 21 Years Obesity during adolescence affects blood pressure, blood lipids, lipoprotein and insulin levels, and psychological well-being. The percentage of obese adolescents has increased markedly over the past 25 years. Food supplied in schools should meet Dietary Guidelines for Americans standards, and schools should ensure that all adolescents engage in 60 minutes of activity during each school day. How the theme of “Promoting Healthy Weight” fits into Bright Futures visits Each Bright Futures health supervision visit is structured around five priority topics that help focus the health care professional’s guidance to parents and children. Some priorities are unique to a particular visit; others are featured often and their components evolve in concert with the child’s development. These examples of priorities, taken from selected visits, show how Bright Futures helps health care professionals talk to families about promoting healthy weight during each developmental stage: Infancy: 9 Month Visit Feeding routine, including self-feeding, mealtime routines, transition to solids and table food, weaning plans, and drinking from a cup Early Childhood: 2 Year Visit Limiting television viewing while promoting reading, physical activity and safe play Middle Childhood: 9 and 10 Year Visits Nutrition and physical activity issues, including weight concerns, body image, physical activity, the importance of breakfast, limiting high-fat foods, choosing water rather than soda or juice, and eating as a family Middle Adolescence: 15 to 17 Year Visits Physical growth and development issues, including physical and oral health, body image, healthy eating, and physical activity Additional Resources on Promoting Healthy weight • American Academy of Pediatrics www.aap.org • Maternal and Child Health Bureau, Health Resources and Services Administration http://mchb.hrsa.gov • Centers for Disease Control and Prevention: Physical Activity for Everyone www.cdc.gov/nccdphp/dnpa/physical/recommendations/young.htm • Henry J. Kaiser Family Foundation www.kff.org • National Association for Sport and Physical Education www.aahperd.org/naspe/template.cfm?template=toddlers.html • National Center for Health Statistics (growth charts) www.cdc.gov/nchs • The President’s Council on Physical Fitness and Sports http://fitness.gov • Dietary Guidelines for Americans, 2005 www.health.gov/dietaryguidelines/dga2005/document/default.htm Bright Futures is a national health care promotion and disease prevention initiative that uses a developmentally-based approach to address children’s health needs in the context of family and community. Other Bright Futures Health Promotion Themes Family Support Support Child Development Mental Health Healthy Weight Healthy Nutrition Physical Activity Oral Health Safety and Injur y Prevention Prevention Community Relationships and Resources Resources Healthy Sexual Development and Sexuality To learn more about Bright Futures, visit www.brightfutures.aap.org.